Delayed onset postoperative retropharyngeal hematoma after anterior cervical surgery with a sequela of tracheal stricture: a case report

Abstract

Background Among the several complications associated with anterior cervical discectomy and fusion (ACDF), airway compromise is considered one of the serious life-threatening conditions and usually requires emergent treatment, including airway establishment and hematoma evacuation surgery. Postoperative retropharyngeal hematoma commonly occurred during the on immediate phase with airway compromise, but have a rarity on late onset of this complication. Enlightened by this existing fact, we report the first case of delayed onset postoperative retropharyngeal hematoma after anterior cervical surgery with a sequela of tracheal stricture. Case presentation A 55-year-old male underwent ACDF for disc herniation at C5–6 that had not responded to conservative treatment over 3 months. The symptoms significantly improved after surgery, and he was discharged on postoperative day 3. On the 7 days after ACDF, the patient complained of sudden-onset left-deviated neck swelling. The follow-up plain radiographs and neck-enhanced computed tomography (CT) scans showed anterior and right lateral displacement of the airway including the trachea by a large retropharyngeal hematoma. We performed an emergent forceful endotracheal intubation that was maintained for 2 days until the patient underwent hematoma evacuation surgery. On the second day after hematoma evacuation surgery, the patient complained of hoarseness with a foul breath odor. Laryngoscopy showed tracheal ischemic mucosal damage that had been induced by forceful endotracheal intubation. Antibiotics and systemic corticosteroids were administered, and the symptoms improved. One month after hematoma evacuation surgery, he complained of dyspnea on exertion, and laryngoscopy showed tracheal stricture. The patient underwent bronchoscopic dilatation and is doing well without recurrence of symptoms. Conclusions Early surgery to remove the delayed onset retropharyngeal hematoma, rather than forceful endotracheal intubation followed by delayed surgery, might yield better results and avoid unexpected complications of tracheal stricture.

Postoperative complications associated with anterior cervical discectomy and three years follow-up

“…Usually, they can be present a few hours after surgery. Retropharyngeal hematomas due to compression can lead to acute airway compromise (27). Therefore, immediate recognition and removal are critical to limit morbidity and mortality.…”

Airway Complications After Anterior Cervical Spine Surgery: Etiology and Risk Factors

“…Postoperative hematoma can lead to airway compromise requiring acute reoperation after ACSS 17 in .4%-1.2% of cases. 18 - 20 Although a compressive hematoma typically presents within the first 24 h of surgery, up to 37% of these are diagnosed after the patient has already been discharged from the hospital, 17 , 21 up to six weeks postoperatively. 22 Potential causes of the development of compressive hematomas include vascular damage, intramuscular bleeding due to excessive intraoperative retraction, ineffective hemostasis, increased blood pressure, and delayed bleeding from arterial aneurysms or dissections.…”